Viral Hepatitis

Hepatitis A
• Hepatitis A virus (HAV) is a usually benign, self-limited
disease with an incubation period of 2 to 6 weeks.

• HAV does not cause chronic hepatitis or a carrier state and

only uncommonly causes acute hepatic failure, so the
fatality rate associated with HAV is only about 0.1-0.3%
• Discovered in 1973, HAV is a small, nonenveloped,
positive-strand RNA picornavirus that occupies its own
genus, Hepatovirus. Ultrastructurally, HAV is an icosahedral
capsid 27 nm in diameter. The receptor for HAV is
HAVcr-1, a 451–amino acid class I integral-membrane
mucin-like glycoprotein.
Hepatitis B
• Hepatitis B virus (HBV) can produce

(1) acute hepatitis followed by recovery and clearance of the

virus
(2) nonprogressive chronic hepatitis,
(3) progressive chronic disease ending in cirrhosis,
(4) acute hepatic failure with massive liver necrosis, and
(5) an asymptomatic, “healthy” carrier state.

HBV-induced chronic liver disease is also an important

precursor for the development of hepatocellular carcinoma
Hepatitis C
• Hepatitis C Virus (HCV) is a major cause of liver disease
worldwide, with approximately 170 million people affected.

• • Intravenous drug abuse (54%)

• Multiple sex partners (36%)
• Having had surgery within the last 6 month (16%)
• Needle stick injury (10%)
• Multiple contacts with an HCV-infected person (10%)
• Employment in medical or dental fields (1.5%)
• Unknown (32%)
• Persistent infection and chronic hepatitis are the hallmarks
of HCV infection, despite the generally asymptomatic nature
of the acute illness.

• In contrast to HBV,
chronic disease occurs in the majority of HCV-infected
individuals (80% to 90%) and cirrhosis eventually occurs
in as many as a 20% of individuals with chronic HCV infection.
• HCV infection is potentially curable. Until recently,
treatment has been based on combination of pegylated
IFN-α and ribavirin and cure rates depended on the viral
genotype;

• patients with genotype 2 or 3 infection generally

have had the best responses. Interestingly, host genotype
also influences the response.
Hepatitis D
• Also called “the delta agent,” hepatitis D virus (HDV) is
a unique RNA virus that is dependent for its life cycle on
HBV. Infection with HDV arises in the following settings :

• Co-infection occurs following exposure to serum containing

both HDV and HBV. The HBV must become
established first to provide the HBsAg necessary for
development of complete HDV virions.
• Superinfection occurs when a chronic carrier of HBV is
exposed to a new inoculum of HDV. This results in
disease 30 to 50 days later presenting either as severe
acute hepatitis.

• With chronic delta hepatitis arising from HDV

superinfection, HBsAg is present in serum, and anti-HDV
antibodies (IgG and IgM) persist for months or longer.
Vaccination for HBV also prevents HDV infection.
Hepatitis E
• Hepatitis E virus (HEV) is an enterically transmitted,
water-borne infection that occurs primarily in young to
middle-aged adults. HEV is a zoonotic disease with animal
reservoirs, such as monkeys, cats, pigs, and dogs.

• A characteristic feature of HEV infection is the high mortality

rate among pregnant women, approaching 20%.
• In most cases the disease is self-limiting; HEV is not associated
with chronic liver disease or persistent viremia in
immunocompetent patients.

• Chronic HEV infection does occur in patients with AIDS

and immunosuppressed transplant patients